Excited Delirium

Abstract

Excited (or agitated) delirium is characterized by agitation, aggression, acute distress and sudden death, often in the pre-hospital care setting. It is typically associated with the use of drugs that alter dopamine processing, hyperthermia, and, most notably, sometimes with death of the affected person in the custody of law enforcement. Subjects typically die from cardiopulmonary arrest, although the cause is debated. Unfortunately an adequate treatment plan has yet to be established, in part due to the fact that most patients die before hospital arrival. While there is still much to be discovered about the pathophysiology and treatment, it is hoped that this extensive review will provide both police and medical personnel with the information necessary to recognize and respond appropriately to excited delirium...

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Excited Delirium Strikes Without Warning

Learning Objective

• Discuss the pathophysiology of excited delirium • Recognize the signs and symptoms excited delirium • Identify the treatment for a patient presenting with excited delirium

Key Terms

Bells Mania: A condition that manifests with mania and fever in which the patient becomes exhausted due to mental excitement. Benzodiazepine: A medication that results in sedative, hypnotic, anxiolytic, anticonvulsant, muscle relaxant and amnesic action. Dissociative agents: Medications that produce a trance-like state by causing interruption of cerebral association pathways between the limbic and cortical systems. Dopamine: A catecholamine neurotransmitter produced in several areas of the brain, including the substantia nigra. Excited delirium: A condition that manifests as a combination of delirium, psychomotor agitation, anxiety, hallucinations, speech disturbances, disorientation, violent and bizarre behavior, insensitivity to pain, elevated body temperature and superhuman strength. Neuroleptic malignant syndrome: A condition that causes delirium and death as a result of abrupt withdrawal from psychiatric medication that blocks dopamine re-uptake....

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